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Little is published about dietary intake of children of ethnic populations found in Hawai'i, due to an absence of national statistics collected on Hawai'i's population. This information is needed to focus planning of food, agriculture and health programs aimed to prevent obesity and related chronic disease and to improve health. Dietary patterns of 156 Native Hawaiian (n=110), Filipino (n=28) and White (n=18) children and their caregivers were compared using socio-demographic, annual "food season," and 24 hour dietary recall data from a baseline survey of four lower income communities selected for an intervention program in rural Hawai'i. Ethnic differences were found in the Healthy Eating Index (HEI) dairy component, and in calcium and vitamin C nutrient intakes among caregivers only (adjusting for food season). Whites always had higher intakes of these foods and nutrients than Filipinos or Native Hawaiians. Vitamin C intake remained significantly different among ethnic groups after further adjusting for dairy food group intake. Dietary patterns showed low intake of fruits and vegetables, fiber and dairy foods among these understudied populations.

This paper presents details the Healthy Foods Hawai'i (HFH) intervention trial, aimed to improve children's dietary behavior to prevent child obesity, by modifying the food environment with community-selected foods. Four communities were selected by ethnic composition, income level, two on O'ahu and one neighbor island. On each island one community was randomly assigned to intervention and one to control. The intervention was implemented through food stores in the intervention communities. HFH was designed to strengthen the network between local food producers, food distributors, storeowners and consumers, to increase the availability of healthier less energy dense foods for children in underserved rural communities of Hawai'i. The intervention includes phases: healthier beverages, snacks, condiments, and family meals. Moderate to high fidelity was achieved for educational materials (shelf labels, posters and educational displays). The number of educational displays varied by intervention phase and community. Posters were found in place 100% of the time. Shelf labels were found intact in the correct location. Low to moderate fidelity was achieved for distributors, with some products not stocked. In the intervention communities, 6-8 week phases focused on target foods with 40 food demonstrations. A total of 1582 food related samples were distributed. A high to moderate dose and reach of the overall intervention was achieved in delivery of the cooking demonstrations. A high to moderate dose and reach of the intervention was achieved overall; fidelity to the intervention protocol was moderate. To improve healthy local food availability in stores in rural communities in Hawai'i, agricultural producers reported needing additional support to sell and transport product to local stores, rather than to centralized distributors.

Diet-related chronic diseases are at epidemic levels in low-income ethnic minority populations. The purpose of this study is to decrease risk for obesity in children by modifying the food environment and conducting point-of-purchase promotions that will lead to changes in psychosocial factors and behaviors associated with healthier food choices among low-income communities with a preponderance of Native Hawaiians and Pacific Islanders. We implemented an intervention trial over a 9-11-month period in five food stores in two low-income multiethnic communities in Hawaii, targeting both children and their adult caregivers. The Healthy Foods Hawaii (HFH) intervention consisted of an environmental component to increase store stocking of nutritious foods, point-of-purchase promotions, interactive sessions, and involved local producers and distributors. We evaluated the impact of the program on 116 child-caregiver dyads, sampled from two intervention and two comparison areas before and after intervention implementation. Program impacts were evaluated using multivariable linear regression. The HFH program had a significant impact on caregiver knowledge and the perception that healthy foods are convenient. Intervention children significantly increased their Healthy Eating Index (HEI) score for servings of grains, their total consumption of water, and showed an average 8.5 point (out of 90 total, eliminating the 10 points for variety, giving a 9.4% increase) increase in overall HEI score. A food store intervention was effective in improving healthy food knowledge and perception that healthy foods are convenient among caregivers, and increased the consumption of several targeted healthy foods by their children. Greater intensity, sustained food system change, and further targeting for children are needed to show greater and sustained change in food-related behaviors in low-income Native Hawaiian and Pacific Islander communities.

Objective: To describe changes in dietary patterns of adolescent girls in Hawaii from 2001 to 2003., Design: Cohort study, with exams 2 years apart., Subjects/setting: One hundred fifty-one girls of Asian, white, and mixed ethnicity who were aged 9 to 14 years at exam 1 and aged 11 to 16 years at exam 2 and lived on the island of Oahu, HI., Methods: Three-day diet records were obtained at each exam. Mean nutrient and food group intakes and weight, height, and body mass index were determined and compared between the two exams., Statistical Analyses: Data are summarized as means+/-standard deviation unless otherwise stated. Differences in values between groups were analyzed for significance using paired t tests and multiple regression., Results: Girls at exams 1 and 2 had mean carbohydrate intakes of 233 g and 241 g, respectively, and protein intakes of 67 g and 65 g, respectively. None of the carbohydrate intakes were below the Estimated Average Requirement (EAR) at exam 1 and only one girl was below at exam 2. Three percent of girls had protein intakes that were below the EAR at exam 1 whereas 9% were below at exam 2. For iron intakes, 3% of girls were below the EAR at exam 1 and 14% of girls were below at exam 2. Girls at exams 1 and 2 had mean calcium intakes of 733 mg and 732 mg, respectively, and fiber intakes of 11.2 g and 11.4 g, respectively; lower than the Adequate Intake recommendation. The percentage of energy from macronutrients in exams 1 and 2, respectively, was in range of the Appropriate Macronutrient Distribution Range for more than 70% of girls (76% for exam 1, 79% for exam 2), but the mean percentage intake of saturated fat intake was higher than the recommended range for more than 65% of the girls at both exams 1 and 2 (69% at exam 1, 73% at exam 2). However, no significant differences were found in percent contribution of or in total intake of macronutrients between the two exams. More than half of girls (51% to 100%) did not consume the recommended number of Food Guide Pyramid Servings for any food group at either exam 1 or 2. A significant increase was found for sweetened carbonated beverage intake (from 130 g to 179 g; P<0.05) and for added sugar intake (from 16 tsp to 18 tsp; P<0.01) between exams 1 and 2, a level well above recommendations. As expected, mean body weight and mean body mass index increased significantly between exams 1 and 2 (P<0.05)., Conclusions: These data suggest high dietary intakes of dietary fat and sugar, and increasing intakes of sweetened carbonated beverages and other high-sugar drinks during adolescence among girls in Hawaii.